Obstetric, perineal, and psychosocial outcomes after successful vaginismus treatment: a retrospective cohort study stratified by Lamont grade.

BACKGROUND: Whether obstetric, perineal, and psychosocial differences persist after successful vaginismus treatment, particularly by pre-treatment severity, remains unclear. METHODS: In this single-center retrospective cohort study, primigravid women who conceived spontaneously after successful vaginismus treatment and delivered between December 2023 and December 2025 (n = 117) were compared with controls selected at a 1:3 ratio for similar maternal age, body mass index, and gestational age at delivery (n = 351). Pre-treatment severity was graded by Lamont (1–4). Outcomes included cesarean delivery (overall and by Lamont grade), cesarean on maternal request, second-stage cesarean, neonatal outcomes, and Obstetric anal sphincter injuries (OASIS) (grades 3a-4). Prenatal psychosocial adjustment was assessed at 30 weeks (PSEQ total and PSEQ-FHL), and postpartum depressive symptom risk at 6 weeks (EPDS ≥ 13). RESULTS: Baseline characteristics were similar. Overall cesarean delivery was comparable (43.6% vs. 36.2%; OR 1.36, 95% CI 0.89–2.09), but Lamont grade 4 had a higher cesarean rate than controls (58.1% vs. 36.2%; OR 2.44, 95% CI 1.16–5.15). Cesarean on maternal request (17.9% vs. 5.4%; OR 3.82, 95% CI 1.97–7.40) and second-stage cesarean (5.1% vs. 0.6%; OR 9.43, 95% CI 1.88–47.40) were more frequent in the treated cohort. In vaginal deliveries (treated n = 66; controls n = 224), minor OASIS (3a-3b) was higher after treatment (9.1% vs. 2.2%; OR 4.38, 95% CI 1.29–14.85), and major OASIS (3c-4) occurred only in Lamont grade 4 (15.4% vs. 0.0%; p = 0.003). EPDS ≥ 13 did not differ overall (30.8% vs. 28.5%). PSEQ scores were higher in treated women, mainly in Lamont grades 3–4, indicating poorer late-pregnancy psychosocial adjustment. CONCLUSIONS: After successful vaginismus treatment, most maternal and neonatal outcomes were similar to controls; however, cesarean on maternal request and second-stage cesarean remained more frequent, minor OASIS was increased in vaginal deliveries, and major OASIS was concentrated in Lamont grade 4. Higher Lamont grades were also associated with poorer prenatal psychosocial adjustment. TRIAL REGISTRATION: Not applicable.